Healthcare Provider Details

I. General information

NPI: 1629558911
Provider Name (Legal Business Name): B & K SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EZELLE ST
RUSTON LA
71270
US

IV. Provider business mailing address

PO BOX 1836
RUSTON LA
71273-1836
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-3126
  • Fax: 318-251-6257
Mailing address:
  • Phone: 318-251-6344
  • Fax: 351-251-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.09659R
License Number StateLA

VIII. Authorized Official

Name: WILLIAM ALEXANDER
Title or Position: SOLE OWNER
Credential: MD
Phone: 318-381-5182